Only at delivery. There are no symptoms during the pregnancy. Accreta presents with a placenta that will not detach after the infant is born. If the placenta is manually removed or removed under traction there is a great deal of bleeding, which may require surgery and possibly a hysterectomy. Accretas can sometimes be diagnosed prior to delivery via ultrasound or mri.
Vaginal bleeding. Placenta accreta is a post-hoc diagnosis made after autopsy (if you are unlucky and it was undiagnosed until delivery), or after pathological examination of the uterus and placenta en bloc (if you are lucky and it was suspected and managed appropriately in a tertiary care center with expert doctors, ICU and large blood bank). It is typically asymptomatic, although it can cause vaginal bleeding.
Don't know. We don't know all the causes, but we know certain folks are at increased risk, such as having multiple c-sections and placenta previa.
Uterine scars/defect. The placenta tends to implant over pre-existing uterine scars or defects; when that occurs, the invasive nature of the placenta can lead to abnormally increased vascularity in areas without sufficient uterine muscle to control the bleeding once the placenta is delivered (particularly near the cervix). That is potentially life-threatening if undiagnosed until delivery and managed in small hospital!
Ultrasound & MRI. An accreta is a more dangerous form of placental abnormality and ultrasound isn't very accurate although it can show signs that concern us. Especially if someone has higher risk factors (previous c-section scar, uterine rupture). An MRI is more diagnostic of a placenta accreta and allows us to make vital preparations for delivery such as blood products, qualified surgeons, & embolization therapy.
Ultrasound, Doppler. The provisional working diagnosis is achieved prenatally with history taking and a targeted ultrasound examination by an expert in the field. Mri is not generally helpful, unless the placental invasion is posteriorly. The final diagnosis is made by pathological examination of the uterus and placenta en bloc after a cesarean hysterectomy.
Uterine scarring. Women with a history of fibroid surgery or previous ceasarean whose placenta implants on scar tissue have a small, but present potential for the placenta to dig in too deeply. It can just happen de novo, too.
Previa/fibroids/scar. Placenta previa (placenta covering the cervix and obstructing the birth canal) is most closely etiologic to placenta accreta. Degenerating uterine fibroids, having had many babies, prior scars on the womb (e.g. Myomectomies, cesarean sections) and multiple d&cs can also lead to placenta accreta with or without placenta previa.
Abnormal. Placenta actually attaches invasively to the uterine muscle rather than the uterine lining as it should. May not be able to be separated when the baby is born.
Placenta accreta. A placenta accreta develops when the placenta invades or grows into the muscular layer of the uterus. With invasion of the muscle, detachment of the placenta after birth of the infant cannot occur. Retention of the placenta can lead to a postpartum hemorrhage. To remove the placenta, the uterus is usually removed after delivery of the infant.
Serious complication. I am sure you mean that your sister has suspected placenta accreta, as this a post hoc diagnosis only possible after the uterus and placenta have been removed en bloc and examined under the pathologist's microscope. This is potentially life-threatening diagnosis that should be managed proactively by experienced doctors and surgeons in large/tertiary care centers with large blood banks and icus.
Resorption. If placenta percreta/accreta is recognized at the time of delivery and there is no bleeding then allowing the uterus to contract and retained placenta to be excreted or absorbed later on its' own volition is a wise course. However, if there is massive uncontrollable bleeding then cesarean hysterectomy is the "default" choice. Uterine balloon "packing" can be also be tried to arrest bleeding.
C-hysterectomy @34w. A planned prelabor cesarean hysterectomy by 34-35 weeks after administration of Betamethasone is the optimal management of placenta accreta. Increta/percreta. This should be done only at tertiary care centers with ICU and blood bank availability and in consultation with oncologist, urologist and even general or vascular surgeon. Do not attempt placental delivery when accretism is suspected!
Planned c-hyst @34 w. Prelabor cesarean hysterectomy at 34-35 weeks after empiric Betamethasone administration in a large tertiary care center with collaboration between mfm, gynecology-oncology, urology, blood bank, neonatology and sicu/general surgery is the optimal approach. Do not attempt to deliver the placenta! Leaving the placenta is nitu can be life-saving if immediate surgical therapy is not possible.
If someone has a focal placenta accreta can it detach and come out on its own? Have you ever heard of this? Or would this be unusual?
Placenta Accreta. Placenta Accreta usually occurs when the placenta attaches to a scar from a previous cesarean section. If the placenta grows into the scar it is called placenta increta. If it grows through the wall of the uterus it is called placenta percreta. These are serious problems which can lead to a cesarean hysterectomy. The diagnosis is suspected by ultrasound or MRI. A focal accreta could detach.
Very definitely. Unfortunately, placenta accreta is often diagnosed at the time post delivery when a cotyledon (plug) of placenta is missing or the placenta itself does not detach normally. At that point, aggressive measures to 'detach" the placenta may result in massive hemorrhage and the resultant post apocalyptic diagnosis of placenta accreta.
No. The concern is for mother. After the baby is born, difficulty with separation and removal of the placenta can result in excess bleeding, a hysterectomy, and a risk to future pregnancies. It should not harm a current pregnancy.
Yes - prematurity, Placenta previa/accreta typically leads to preterm contractions and rupture of membranes requiring delivery before 37 weeks. Thus, the minor risk is for mild prematurity for the fetus/neonate. The main risk is maternal and can prove lethal if the diagnosis is not prenatally suspected and appropriate expert care is not sought in a timely fashion.